Research office seen as turning point in ER care
Aseemingly small move by the National Institutes of Health—creating an Office of Emergency Care Research—could have a big effect on the quality of care throughout a hospital and also within a physician’s office.
In designating a team to work full time on shepherding emergency-care researchers through the process of obtaining funding from the NIH, as it did last week, the NIH is encouraging more of the type of research that is not easily done outside of an emergency department. Emergency room care often spans disciplines, and patients are often still very early in the treatment process, a time that can be important to their recovery and related research, ER care experts say.
“We (are) calling it one of the greatest days in emergency medicine history,” said Dr. Sandra Schneider, immediate past president of the American College of Emergency Physicians and a professor of medicine at the University of Rochester, N.Y. The creation of the office recognizes that emergency-care researchers have become skilled enough to warrant more attention by the NIH and that emergency-care research is unique, Schneider said.
The new office, called OECR and pronounced like the word “ocher,” will not be awarding its own NIH funds, but having an office to champion the area is going to make it easier and more likely for researchers from all disciplines to get prestigious NIH funding in emergency care. The office will help researchers figure out how to apply for funds and help the NIH identify cross-cutting research areas it may have missed previously, experts say.
Dr. Walter Koroshetz, acting director of OECR and deputy director of the National Institute of Neurological Disorders and Stroke, said that while it’s difficult to ascertain how much NIH-funded emergency-care research is taking place currently, he would expect that in 10 years the amount should be double or five times what it is now as a result of creating OECR.
Until the creation of OECR, emergencycare researchers were without a home at the NIH, having to apply for funding within a unit focused on a single type of care for research that may also carry a heavy component related to a different NIH institute. For example, a researcher looking at an aspect of chest pain might have to apply for funds through the National Heart, Lung, and Blood Institute, even though chest pain can be indicative of any number of conditions, such as a psychiatric disorder, Koroshetz said.
He said that despite the lack of funding ability, OECR will have influence at the NIH given the active involvement of high-level NIH officials and those who award research money. A steering committee overseeing the office is composed of the directors of the National Institute of General Medical Sciences; the National Heart, Lung, and Blood Institute; the National Institute of Neurological Disorders and Stroke; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Institute of Nursing Research. In addition, the NIH Emergency Care Research Working Group, with more than 20 members from close to 20 institutes, centers and offices, will coordinate the emergency-care research.
The office will be a part of the National Institute of General Medical Sciences and will be composed of a director, a deputy director and an analyst, according to Koroshetz.
The creation of OECR also is a symbolic victory for emergency-care research. Emergency care is a relatively new discipline, and early projects may not have been of high enough quality to meet the standards of the NIH for its funding. But over time, emergency-care researchers have built their skills and the quality of their research, Schneider said.
A turning point in the recognition of the value of emergency-care research came in 2006 with the publication of the Institute of Medicine report Hospital-Based Emergency Care: At the Breaking Point, said Dr. Arthur Kellermann, who holds the Paul O’NeillAlcoa Chair in Policy Analysis for Rand Corp., Santa Monica, Calif. At a subsequent House hearing conducted by the Committee on Oversight and Government Reform, legislators put the NIH on the spot regarding what it was doing to solve the problems highlighted in the IOM report, Kellermann said.
NIH officials then began addressing the matter seriously, Kellermann said. The NIH created a task force and held a series of roundtables culminating in the announcement last week. “The light kind of went on at the NIH.”